Platteville Wrestling Club Youth Tournament

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					                       Platteville/Belmont Wrestling Club Youth Tournament
                                           Sunday, January 15th, 2012
                                                   Belmont High School
                                       646 E Liberty Street, Belmont, WI 53510
                        Take US Hwy 151 to exit 26, then south on Hwy 126 into Belmont
                                             and then left on East Liberty St.

                                            Weigh In: 7:30 a.m. to 9:00 a.m.
                       Division: K-2; 3-4; on divided mats in one gym and 5-6 on ½ mats
                                  Division: 7-8 grades on full mats in separate gym
                                 K-6 Trophies 1st place, Medals 2nd, 3rd and 4th place
                                          7-8 Medals 1st, 2nd, 3rd and 4th place
                                                    “Pins” for match pins
                          Team Trophies 1st, 2nd and 3rd (10 person team, $10 entry fee)
                                                     Entry Fee: $12.00
                                                   Spectator Fee: $1.00
                              USA Card Required and may be purchased online at:
                                               Concessions Served All Day
                                           Questions/Information Requests to
              Jess Brecke 608-348-2640 ( or Nate Runde 608-732-2251
        Register at the door or you may bring the completed form with you to speed the registration

Name: __________________________________________________ Grade: _____________
Age: ____ Birth date: ____________Club: __________________________ USA ID: _____________
Address: ________________________________ Parent: _____________________________
City: _______________________ State: ________ ZIP: ________ Phone: _______________
In consideration of my son/daughter’s acceptance into the Platteville/Belmont Youth Wrestling
Tournament, January 15th, 2012, my heirs, executors, and administrators waive and release parents,
coaches, sponsors, their agents, representatives, committees, and members from any, and all, claims
of rights to damage for injuries in competing in this tournament. Therefore, I waive all claims that I
might have against Belmont School District and/or Platteville and/or Belmont Youth Wrestling Clubs.
Parent/Guardian Signature: _____________________________________________________

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